| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9410 |
|
2,974 |
2,551 |
$284K |
| D0160 |
|
1,400 |
1,323 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,030 |
1,000 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
300 |
62 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
119 |
68 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,269 |
1,130 |
$15K |
| D0460 |
|
528 |
479 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
379 |
370 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
75 |
75 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
24 |
$2K |